HEART-LIVER TRANSPLANT FACES RISKS

Leyla Kokmen, Tribune Staff WriterCHICAGO TRIBUNE

This holiday season will be a critical one for a 48-year-old Chicago man who became the first person in Illinois to undergo a combination heart and liver transplant, University of Chicago doctors said Friday.

After more than 12 hours of surgery Thursday, Wilfredo Ramos joined a handful of patients in the nation to have the rare and difficult surgery, his doctors said.

Performed alone, heart and liver transplants are extremely difficult procedures, said Dr. Mario Albertucci, the surgeon who led the heart transplant team.

"A newly transplanted heart has to have some time to recover. If you combine the two operations, it creates some problems--the heart has to immediately be able to handle the stress of a major abdominal operation," Albertucci said. "It's like asking a newborn child to walk the marathon."

Ramos, a Vietnam veteran, received his new heart first, in a procedure that lasted from 10:30 a.m. to 3 p.m. Dr. Michael Millis' liver transplant team then took over, operating until 11 p.m., said hospital spokesman Bill Burton.

Dr. Solomon Aronson led the team of anethesiologists who monitored Ramon and kept him alive during the strenuous operation.

Both organs came from the same donor, which could help reduce the stress on the patient's immune system, Albertucci said.

Ramos, a father of three and grandfather of two, was in critical but stable condition Friday, which is typical after transplant surgery, Burton said.

"He's recovered extremely well, probably exceeding our expectations. But there are a lot of hurdles ahead of us," Albertucci said.

The first 24 hours are critical for the heart transplant, and the first week is crucial for the liver, he said.

During the first week, major risks include organ failure, bleeding and infection, and later, the possibility of organ rejection becomes more acute, Millis said.

Ramos had been on the organ transplant waiting list for about three weeks, Millis said, and was hospitalized in intensive care the entire time.

Combined heart and liver transplants are extremely rare, because it is unusual to find a patient with two major organs so diseased that they must be replaced, yet who is otherwise healthy enough to tolerate the difficult surgery, Millis said.